What You Should Know Before Getting a Prosthetic Leg
Prosthetic legs, or prostheses, can help people with legamputationsget around more easily. They mimic the function and, sometimes, even theappearance of a real leg. Some people still need a cane, walker or crutchesto walk with a prosthetic leg, while others can walk freely.
If you have a lower limb amputation, or you will soon, a prosthetic leg isprobably an option you’re thinking about.Amputee rehabilitation specialist Mary Keszler, M.D., shares a few considerations you should take into account first.
While many people with limb loss do well with their prosthetic legs, noteveryone is a good candidate for a leg prosthesis. A few questions you maywant to discuss with your doctor before opting for a prosthetic leginclude:
- Is there enough soft tissue to cushion the remaining bone?
- How much pain are you in?
- What is the condition of the skin on the limb?
- How much range of motion does the residual limb have?
- Is the other leg healthy?
- What was your activity level before the amputation?
- What are your mobility goals?
The type of amputation (above or below the knee) can also affect yourdecision. It’s generally easier to use a below-the-knee prosthetic leg thanan above-the-knee prosthesis. “If the knee joint is intact, the prostheticleg takes much less effort to move and allows for more mobility,” explainsKeszler.
The reason behind the amputation is also a factor, as it may impact thehealth of the residual limb. Your physical health and lifestyle are alsoimportant to consider. If you were not very active and lost your leg due toperipheral vascular diseaseordiabetes, for example, you will struggle more with a prosthesis than someone whowas extremely active but lost a limb in a car accident.
When it comes to amputation, each person is unique. The decision to moveforward with a prosthesis should be a collaborative one between you andyour doctor.
To get the right type and fit, it’s important to work closely with your prosthetist — a relationship you might have for life.
Mary Keszler, M.D.
If your doctor prescribes a prosthetic leg, you might not know where tobegin. It helps to understand how different parts of a prosthesis worktogether:
- The prosthetic leg itself is made of lightweight yet durable materials. Depending on the location of the amputation, the leg may or may not feature functional knee and ankle joints.
- The socket is a precise mold of your residual limb that fits snugly over the limb. It helps attach the prosthetic leg to your body.
- The suspension system is how the prosthesis stays attached, whether through sleeve suction, vacuum suspension/suction or distal locking through pin or lanyard.
There are numerous options for each of the above components, each withtheir own pros and cons. “To get the right type and fit, it’s important towork closely with your prosthetist — a relationship you might have forlife,” recommends Keszler.
Aprosthetistis a health care professional who specializes in prosthetic limbs and canhelp you select the right components. You’ll have frequent appointments,especially in the beginning, so it’s important to feel comfortable with theprosthetist you choose.
Rehabilitation Is an Ongoing, Collaborative Process
Once you’ve selected your prosthetic leg components, you will needrehabilitation to strengthen your legs, arms and cardiovascular system, asyou learn to walk with your new limb.
You’ll work closely withrehabilitation physicians, physical therapists and occupational therapiststo develop a rehabilitation plan your mobility goals. A big partof this plan is to keep your healthy leg in good shape.
“Your healthy legis worth its weight in gold,” emphasizes Keszler. “While prosthetictechnology is always advancing, nothing can replicate a healthy leg.”
Having the support of a dedicated team of experts is essential when recovering from the amputation of a limb. At Johns Hopkins, our team of physiatrists, orthotists, prosthetists, physical and occupational therapists, rehabilitation psychologists and other specialists works together to create your custom rehabilitation plan.
Learning to get around with a prosthetic leg can be a challenge. Even afterinitial rehabilitation is over, you might experience some issues that yourprosthetist and rehabilitation team can help you manage. Common obstaclesinclude:
- Excessive sweating (hyperhidrosis), which can affect the fit of the prosthesis and lead to skin issues.
- Changing residual limb shape. This usually occurs in the first year after an amputation as the tissue settles into its more permanent shape, and may affect the fit of the socket.
- Weakness in the residual limb, which may make it difficult to use the prosthesis for long periods of time.
- Phantom limb pain could be intense enough to impact your ability to use the prosthesis.
A Note on Phantom Limb Pain
Phantom limb pain, or pain that seems to come from the amputated limb, is avery real problem that you may face after an amputation. “About 80% ofpeople with amputations experience phantom limb pain that has no clearcause, although pain in the limb before amputation may be a risk factor,”says Keszler.
Mirror therapy, where you perform exercises with a mirror, may help with certain types ofphantom limb pain. “Looking at yourself in the mirror simulates thepresence of the amputated leg, tricking the brain into thinking it’s stillthere, stopping the pain,” explains Keszler.
In other cases, phantom limb pain might stem from another conditionaffecting the residual limb, such assciaticaor neuroma. Addressing these root causes can help eliminate the phantompain.
Your Leg Prosthesis Needs May Change
At some point, you may notice that you aren’t as functional as you’d to be with your current leg prosthesis.
Maybe your residual limb hasstabilized and you’re ready to transition from a temporary prosthesis thatlasts a few months to one that can last three to five years.
Or maybeyou’ve “outwalked” your prosthesis by moving more or differently than theprosthesis is designed for. New pain, discomfort and lack of stability aresome of the signs that it may be time to check in with your prosthetist toreevaluate your needs.
Your prosthetist might recommend adjusting your current equipment orreplacing one of the components. Or you might get a prescription for a newprosthetic leg, which happens on average every three to five years. If youreceive new components, it’s important to take the time to understand howthey work. Physical therapy can help adjust to the new components or yournew prosthetic leg.
Prosthetic Leg Technology Is Always Evolving
There are always new developments in prosthetic limb technology, such asmicroprocessor-driven and activity-specific components.
- Microprocessor joints feature computer chips and sensors to provide a more natural gait. They may even have different modes for walking on flat surfaces or up and down the stairs.
- There are also specialized prosthetic legs for different activities, such as running, showering or swimming, which you can switch to as needed. In some cases, your everyday prosthetic leg can be modified by your prosthetist to serve different purposes.
- Osseointegration surgery is another option. This procedure involves the insertion of a metal implant directly into the bone, so there is no need for a socket. The prosthetic leg then attaches directly to that implant. While this procedure is not right for everyone and is still under study, it can provide improved range of motion and sensory perception.
It’s important to remember that you’re not alone in navigating the manydifferent prosthetic leg options. Your care team will help you weigh thepros and cons of each and decide on the ideal prosthetic leg that matchesyour lifestyle.